Effect of Portable Non-Invasive Ventilation on Exercise Tolerance in COPD: One Size Does Not Fit All

Nikolaos Chynkiamis; Matthew Armstrong; Emily Hume; Charikleia Alexiou; Lauren Snow; Nicholas Lane; Tom Hartley; Stephen C. Bourke; Ioannis Vogiatzis

doi:10.1016/j.resp.2020.103436

Effect of Portable Non-Invasive Ventilation on Exercise Tolerance in COPD: One Size Does Not Fit All

Nikolaos Chynkiamis, Matthew Armstrong, Emily Hume, Charikleia Alexiou, Lauren Snow, Nicholas Lane, Tom Hartley, Stephen C. Bourke, Ioannis Vogiatzis

Sport Exercise and Rehabilitation Department

Research output: Contribution to journal › Article › peer-review

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Abstract

In a cross-over RCT, portable NIV (pNIV) reduced dynamic hyperinflation (DH) compared to pursed lip breathing (PLB) during recovery from intermittent exercise in COPD, but not consistently in all subjects. In this post-hoc analysis, DH response was defined as a reduction ≥4.5% of predicted resting inspiratory capacity with pNIV compared to PLB.
At exercise iso-time (where work completed was consistent between pNIV and PLB), 8/24 patients were DH non-responders (DH: 240±40ml, p=0.001 greater using pNIV). 16/24 were DH responders (DH: 220±50ml, p=0.001 lower using pNIV). Compared to DH responders, DH non-responders exhibited greater resting DH (RV/TLC: 65±4% versus 56±2%; p=0.028) and did not improve exercise tolerance (pNIV: 30.9±3.4 versus PLB: 29.9±3.3 min; p=0.603). DH responders increased exercise tolerance (pNIV: 34.9±2.4 versus PLB: 27.1±2.3 min; p=0.001). Resting RV/TLC% was negatively associated with the magnitude of DH when using pNIV compared to PLB (r=-0.42; p=0.043).
Patients with profound DH were less likely to improve exercise tolerance with pNIV. Further studies using auto-adjusted ventilators are warranted.

Original language	English
Article number	103436
Number of pages	7
Journal	Respiratory Physiology and Neurobiology
Volume	277
Early online date	5 Apr 2020
DOIs	https://doi.org/10.1016/j.resp.2020.103436
Publication status	Published - 1 Jun 2020

Keywords

COPD
Exercise tolerance
Non-invasive ventilation
Pulmonary rehabilitation

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10.1016/j.resp.2020.103436

Chynkiamis_et_al_Respir_Physiol_NeurobiolAccepted author manuscript, 446 KBLicence: CC BY-NC-ND

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@article{d0741943152c43eeb0db407519be47ee,

title = "Effect of Portable Non-Invasive Ventilation on Exercise Tolerance in COPD: One Size Does Not Fit All",

abstract = "In a cross-over RCT, portable NIV (pNIV) reduced dynamic hyperinflation (DH) compared to pursed lip breathing (PLB) during recovery from intermittent exercise in COPD, but not consistently in all subjects. In this post-hoc analysis, DH response was defined as a reduction ≥4.5% of predicted resting inspiratory capacity with pNIV compared to PLB.At exercise iso-time (where work completed was consistent between pNIV and PLB), 8/24 patients were DH non-responders (DH: 240±40ml, p=0.001 greater using pNIV). 16/24 were DH responders (DH: 220±50ml, p=0.001 lower using pNIV). Compared to DH responders, DH non-responders exhibited greater resting DH (RV/TLC: 65±4% versus 56±2%; p=0.028) and did not improve exercise tolerance (pNIV: 30.9±3.4 versus PLB: 29.9±3.3 min; p=0.603). DH responders increased exercise tolerance (pNIV: 34.9±2.4 versus PLB: 27.1±2.3 min; p=0.001). Resting RV/TLC% was negatively associated with the magnitude of DH when using pNIV compared to PLB (r=-0.42; p=0.043).Patients with profound DH were less likely to improve exercise tolerance with pNIV. Further studies using auto-adjusted ventilators are warranted.",

keywords = "COPD, Exercise tolerance, Non-invasive ventilation, Pulmonary rehabilitation",

author = "Nikolaos Chynkiamis and Matthew Armstrong and Emily Hume and Charikleia Alexiou and Lauren Snow and Nicholas Lane and Tom Hartley and Bourke, {Stephen C.} and Ioannis Vogiatzis",

note = "Funding information: The study was supported by Philips Respironics (HRC-GRA-17,030-VBREATH-SH), Northumbria Healthcare NHS Foundation Trust and Northumbria University Newcastle.",

year = "2020",

month = jun,

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doi = "10.1016/j.resp.2020.103436",

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volume = "277",

journal = "Respiratory Physiology and Neurobiology",

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T1 - Effect of Portable Non-Invasive Ventilation on Exercise Tolerance in COPD

T2 - One Size Does Not Fit All

AU - Chynkiamis, Nikolaos

AU - Armstrong, Matthew

AU - Hume, Emily

AU - Alexiou, Charikleia

AU - Snow, Lauren

AU - Lane, Nicholas

AU - Hartley, Tom

AU - Bourke, Stephen C.

AU - Vogiatzis, Ioannis

N1 - Funding information: The study was supported by Philips Respironics (HRC-GRA-17,030-VBREATH-SH), Northumbria Healthcare NHS Foundation Trust and Northumbria University Newcastle.

PY - 2020/6/1

Y1 - 2020/6/1

N2 - In a cross-over RCT, portable NIV (pNIV) reduced dynamic hyperinflation (DH) compared to pursed lip breathing (PLB) during recovery from intermittent exercise in COPD, but not consistently in all subjects. In this post-hoc analysis, DH response was defined as a reduction ≥4.5% of predicted resting inspiratory capacity with pNIV compared to PLB.At exercise iso-time (where work completed was consistent between pNIV and PLB), 8/24 patients were DH non-responders (DH: 240±40ml, p=0.001 greater using pNIV). 16/24 were DH responders (DH: 220±50ml, p=0.001 lower using pNIV). Compared to DH responders, DH non-responders exhibited greater resting DH (RV/TLC: 65±4% versus 56±2%; p=0.028) and did not improve exercise tolerance (pNIV: 30.9±3.4 versus PLB: 29.9±3.3 min; p=0.603). DH responders increased exercise tolerance (pNIV: 34.9±2.4 versus PLB: 27.1±2.3 min; p=0.001). Resting RV/TLC% was negatively associated with the magnitude of DH when using pNIV compared to PLB (r=-0.42; p=0.043).Patients with profound DH were less likely to improve exercise tolerance with pNIV. Further studies using auto-adjusted ventilators are warranted.

AB - In a cross-over RCT, portable NIV (pNIV) reduced dynamic hyperinflation (DH) compared to pursed lip breathing (PLB) during recovery from intermittent exercise in COPD, but not consistently in all subjects. In this post-hoc analysis, DH response was defined as a reduction ≥4.5% of predicted resting inspiratory capacity with pNIV compared to PLB.At exercise iso-time (where work completed was consistent between pNIV and PLB), 8/24 patients were DH non-responders (DH: 240±40ml, p=0.001 greater using pNIV). 16/24 were DH responders (DH: 220±50ml, p=0.001 lower using pNIV). Compared to DH responders, DH non-responders exhibited greater resting DH (RV/TLC: 65±4% versus 56±2%; p=0.028) and did not improve exercise tolerance (pNIV: 30.9±3.4 versus PLB: 29.9±3.3 min; p=0.603). DH responders increased exercise tolerance (pNIV: 34.9±2.4 versus PLB: 27.1±2.3 min; p=0.001). Resting RV/TLC% was negatively associated with the magnitude of DH when using pNIV compared to PLB (r=-0.42; p=0.043).Patients with profound DH were less likely to improve exercise tolerance with pNIV. Further studies using auto-adjusted ventilators are warranted.

KW - COPD

KW - Exercise tolerance

KW - Non-invasive ventilation

KW - Pulmonary rehabilitation

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DO - 10.1016/j.resp.2020.103436

M3 - Article

C2 - 32259687

SN - 1569-9048

VL - 277

JO - Respiratory Physiology and Neurobiology

JF - Respiratory Physiology and Neurobiology

M1 - 103436

ER -

Effect of Portable Non-Invasive Ventilation on Exercise Tolerance in COPD: One Size Does Not Fit All

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